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Public Works <br />Maintenance <br />1820 Roosevelt Blvd. <br />97402 <br />rLocation of <br />Wastewater Connection O w* <br />(^iTesi-Hoo <br />Property Information <br />Address -----1:— ----- <br />Map and Tax Lot—^ <br />Building Type: ^TSFD <br />^nrr\\j- C^ <br />VA)iec\ngrt~ <br />□ Duplex "□ Multi-^Family □ Commercial □ Industrial <br />Owner <br />r: rmimtaL- <br />Contractor/Plumber' — <br />Right of Way Cut Permit Required <br />Installation Date —!~i—1 ^ ~ | J----------- <br />, Pcrmtetk*} grented fa Mocfi prtntt ——r ccnivctfon to putOa <br />Date of Issue 1 c) - j <br />Pipe Material • H ^ Pipe Diameter. <br />□ System Development Charge□ <br />Inspected By <br />h eenkinriitcnc* to Ctty tiandorcfa end tp^dlkaVcm. <br />Public Wastewater .Information <br />Index Page.No.,-----Segment No. C^JUri ,Contract No. <br />t / <br />^—)1Q <br />M ^3775- <br />3o' <br />' V is^deeTo. <br />c, / <br />I <br />v?l5 <br />^■3 ^